The potential high-risk population for lung cancer screening: determination of initial screening age and heterogeneity in histology and sex.

Background: In 2021, the US Preventive Services Task Force expanded the initial age for lung cancer screening from 55 to 50 years, which other associations have not followed. The objective of this study was to evaluate the beneficiary age range for lung cancer screening and assess the potential heterogeneity in tumor histology and patient sex.

Methods: Using the Surveillance, Epidemiology, and End Results database, patients with non-small cell lung cancer (NSCLC) between 2011 and 2016 were included. The estimation of overall survival (OS) and lung cancer-specific survival (LCSS) was conducted for survival analysis among three different age groups: 45-49 (n=4,203), 50-54 (n=10,126), and 55-59 years (n=17,122), adjusting for other clinicopathological characteristics.

Results: Significant differences were observed in OS {hazard ratio (HR) [95% confidence interval (CI)]: 0.94 (0.92-0.96)} and LCSS [HR (95% CI): 0.94 (0.91-0.97)] for patients aged 50-54 compared to those aged 55-59. However, no survival advantage was observed for patients aged 45-49 [HR (95% CI) for OS: 0.97 (0.93-1.01), HR (95% CI) for LCSS: 0.98 (0.93-1.02)]. Similar survival trends were observed in patients with adenocarcinoma whereas no difference among those with squamous cell carcinoma across all age groups. Among patients aged 40-45, we observed a significant survival advantage for males, with no corresponding advantage in females.

Conclusions: Patients aged 50 to 54 can benefit from lung cancer screening, in accordance with the recommendations of the US Preventive Services Task Force (USPSTF). The benefits are probably more apparent in adenocarcinoma cases. Younger male patients may benefit more than female patients, which may reflect the need for sex differences in cancer screening.